One of the things I enjoy most about my work is seeing how customers use our TELUS Health solutions to make a real difference for their practices and for their patients. I recently spoke with Mike Brand who is the Manager of Alberta’s Taber Clinic. I was really inspired about the transformative work that his team is doing with their electronic medical record (EMR) system. This is a great story that, I believe, shows the promise of EMR for Canada’s healthcare system.
Taber is a rural community about two hours south of Calgary and an hour north of the Montana border. Because it is located more than 30 minutes away from the closest urban centre of Lethbridge, the Taber Clinic’s funding model is based on capitation – a fixed payment from the Alberta government based on population, rather than the more common fee for service model.
This funding model was a catalyst for the clinic to start taking a closer look at how it could provide more efficient service. Their vision was to provide evidence-based care to its 20,000 patients and today the Taber Clinic is a poster child for team-based care that incorporates EMR technology to achieve dramatic improvements to clinic efficiency as well as the quality of patient care.
Taber is a busy clinic. More than 16,000 of their patients are assigned to one of 13 physicians. With team-based care, a physician acts as team lead and their patient will interact with a variety of team members depending on needs. For example, a medical office assistant (MOA), who has a one-on-one relationship with a physician, will start charts, take blood pressures, measure heights and weights and, unlike most other clinics, is also responsible for planning routine screenings for the day’s patients. The clinic also staffs nurse practitioners, registered nurses, licensed practical nurses, a psychiatric nurse, psychologist, dietician and health coaches.
Since implementing the Wolf EMR system in 2007 (now part of the TELUS Health EMR suite of solutions), the clinic has reduced the average time it takes to book appointments from as many as 30 days down to an average of three. They’ve also been able to reduce visits to the emergency room, with only 4,900 visits last year instead of the anticipated 6,000-plus.
What’s their secret? Mike attributes these results in large part to a lot of hard work by the clinic staff and systems changes that took place, as well as having an effective EMR to provide data and statistics as needed.
I also believe that a key success factor was the fact that Taber proactively tackled clinic workflow and enhanced its strong culture of teamwork at the same time as implementing an EMR system. In fact, Mike emphasized something that I’ve heard from many of our successful customers: that it has to start with leadership – physicians absolutely need to be engaged and empower their staff to do this work.
So, how does this work? Here’s Taber Clinic’s four-step process.
The first step: data collection.
The clinic needed to standardize how it collected data at the point of care. Diagnoses needed to be coded consistently and investigation results classified correctly. Every team member understands the vital role data collection plays in patient care.
The second step: data analysis.
The clinic translated healthcare guidelines into rules, which are database searches that sift through the captured data to identify patient populations and health targets. At the point of care, staff can immediately see what tests a patient requires.
The third step: actionable information.
The clinic turned its data into information staff can act on by setting up EMR system alerts. The rules that were established in step two automatically create alerts, which then appear on a patient’s electronic chart. All team members, from the MOA to the physician, are tasked with resolving alerts in a patient’s chart within the scope of their responsibilities.
Rules are now part of Taber Clinic’s culture and Mike’s staff knows that if they see an alert, they need to deal with it within their scope of responsibility.
In some cases, alerts have saved lives. As a farming community, the clinic sees lots of lumps and bumps. One patient who had suffered a large laceration in her head after being bucked off her horse came into the clinic for a dressing change. Alerts on her chart indicated that she was due for an ECG. The resulting test showed a 90% blockage in her arteries and the next day she was in the hospital having a life-saving stent put in. And this is just one of several examples.
The final step: measuring progress.
With data being recorded consistently, alerts being addressed at the point of care and rules initiating appropriate follow-ups, the EMR system can take snapshots of the clinic’s data and produce run charts that demonstrate how efforts are improving and how well the clinic is adhering to its healthcare guidelines.
Run charts are mainly used by clinic management to assess performance and recommend changes or best practices. But they are also used by staff. At Taber, clinic-wide results were initially posted for all to see and individual team results were shared only with that team. Teams quickly began sharing results between themselves, as everyone wanted to know how they ranked compared to their peers.
This friendly spirit of competition proved to be a great motivator within the clinic and has enabled the team to continually improve its efficiency and service to the community. It makes the Taber Clinic a great example to share on how the future of Canadian EMR can positively impact lives.
Check out more about the Taber Clinic here: http://www.chinookprimarycarenetwork.ab.ca/clinics/clinic.php?view=19
Ron Sparks is head of sales at TELUS Physician Solutions